The cardiotoxicity of anthracyclines continues to present a significant problem in cancer chemotherapy. A detailed systemic review was made of the mechanism mediating this cardiotoxicity, and of the strategies that can be adopted to prevent or modify this complication. Coadministration of ICRF-187, a bis-keto piperazine, with anthracyclines has been found to be the most effective agent to minimize the cardiotoxic effects of doxorubicin and other anthracyclines. ICRF-187 functions as an intracellular chelator of iron, which is needed to catalyze the doxorubicin-mediated formation of oxygen free radicals that cause the cardiac damage.